Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis
BackgroundCOVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-10-01
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| Series: | JMIR Pediatrics and Parenting |
| Online Access: | https://pediatrics.jmir.org/2022/4/e31579 |
| _version_ | 1797734742069608448 |
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| author | John Muthuka Michael Kiptoo Kelly Oluoch Japheth Mativo Nzioki Everlyn Musangi Nyamai |
| author_facet | John Muthuka Michael Kiptoo Kelly Oluoch Japheth Mativo Nzioki Everlyn Musangi Nyamai |
| author_sort | John Muthuka |
| collection | DOAJ |
| description |
BackgroundCOVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results.
ObjectiveThe aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis.
MethodsWe searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation.
ResultsA total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42).
ConclusionsBeing pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity.
Trial RegistrationPROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011. |
| first_indexed | 2024-03-12T12:47:47Z |
| format | Article |
| id | doaj.art-bf1ce04b86e844999ba14c81d4f943a6 |
| institution | Directory Open Access Journal |
| issn | 2561-6722 |
| language | English |
| last_indexed | 2024-03-12T12:47:47Z |
| publishDate | 2022-10-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Pediatrics and Parenting |
| spelling | doaj.art-bf1ce04b86e844999ba14c81d4f943a62023-08-28T23:12:58ZengJMIR PublicationsJMIR Pediatrics and Parenting2561-67222022-10-0154e3157910.2196/31579Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysisJohn Muthukahttps://orcid.org/0000-0002-6207-5249Michael Kiptoohttps://orcid.org/0000-0002-2960-2449Kelly Oluochhttps://orcid.org/0000-0002-8453-2009Japheth Mativo Nziokihttps://orcid.org/0000-0002-0094-1180Everlyn Musangi Nyamaihttps://orcid.org/0000-0002-2064-0713 BackgroundCOVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. ObjectiveThe aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. MethodsWe searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. ResultsA total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42). ConclusionsBeing pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial RegistrationPROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011.https://pediatrics.jmir.org/2022/4/e31579 |
| spellingShingle | John Muthuka Michael Kiptoo Kelly Oluoch Japheth Mativo Nzioki Everlyn Musangi Nyamai Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis JMIR Pediatrics and Parenting |
| title | Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis |
| title_full | Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis |
| title_fullStr | Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis |
| title_full_unstemmed | Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis |
| title_short | Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis |
| title_sort | association of pregnancy with coronavirus cytokine storm systematic review and meta analysis |
| url | https://pediatrics.jmir.org/2022/4/e31579 |
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